Discuss treatment escalation and withdrawal of care decision making

Question 1

How can a patient be assessed for frailty? (3)

Answer 1

• Gp records
• PRISMA-7
• Gait speed test

Question 2

What are 3 things that must be considered when prescribing for a frail patient?

Answer 2

1. each drug should be justified
2. each drug should not be causing any side effects
3. each drug should be easy for the patient to manage

Question 3

Why do patients tend to steadily accumulate medication during their lifetime?

Answer 3

due to comorbidity and the trend to prescribe for prevention

Question 4

What are the PRISMA 7 questions and what score indicates frailty?

Answer 4

1. Age 85+?
2. Male?
3. Any general health problems that require you to limit your activities?
4. Do you need someone to help you on a regular basis?
5. Any general health problems that require you to stay at home?
6. In case of need can you count on someone close to you?
7. Mobility aids?

A score of 3+

Question 5

What is the STOPP START tool?

Answer 5

Screening Tool of Older People’s potentially inappropriate Prescriptions

Question 6

What is frailty?

Answer 6

an age-related, multi-dimensional state of decreased physiological reserves

Question 7

What are 4 physiological changes in the elderly?

Answer 7

1. changes in body composition with loss of lean body mass
2. loss of muscle strength and poor balance
3. decline in renal function
4. changes in metabolism of drugs cleared by the liver

Question 8

What is the purpose of the approach to care in older people?

Answer 8

To improve quality of life

Question 9

When could the gait speed test indicate frailty?

Answer 9

an average gait speed of longer than 5 seconds to walk 4 meters